Renaming monkeypox to Mpox: correspondence
Authors: Parul C. Gupta, Prakasini Satapathy, Ankur Gupta, Bijaya K. Padhi, Ranjit Sah
Journal: International Journal of Surgery (2023)

Highlights The naming of the virus as the monkeypox virus relates to its first report in caged cynomolgus monkeys in 1958 in Copenhagen, Denmark. The natural host of the monkeypox virus is still unclear. WHO suggested embracing mpox as the novel, and mpox shall replace monkeypox as the selected name following a year phase-out period. Dear Editor, The naming of the virus as monkeypox virus relates to its first report in caged cynomolgus monkeys in 1958 in Copenhagen, Denmark, which caused a smallpox-like disease1. With a close resemblance to other established poxviruses, it was called the monkeypox virus2. However, the name monkeypox is debatable as the natural host of the virus is unclear. Scientific communities have called it monkeypox for the past 64 years since its discovery in 1958. Since the disease was mainly restricted to African countries, it did not receive enough attention and remained a neglected disease before the current outbreak. The global media used photographs of Africans and African-Americans to present the mpox lesions. Despite the 2022 mpox outbreak sustaining predominantly among the whites (Westerns), depicting African-Americans with pox lesions led to unhealthy propaganda that negatively stereotyped the African race while overwhelmingly protecting other races. The media of Africa portrayed its displeasure and encouraged the world media to refrain from such photos illustrating the epidemic instances in Europe3. They felt that no race or complexion should be the face of disease. Stigma is an ongoing concern, as the current outbreak is primarily noticed in Men having Sex with Men4. Like HIV, mpox may transmit through sex. Such nomenclature is not only inaccurate but also discriminatory, misleading and stigmatising, especially for this community. Before the 2022 mpox epidemic, the renaming of all the orthopoxviruses, including mpox virus, had already been initiated5. With the mpox outbreak in the first half of 2022, racially prejudiced and stigmatising language urged the WHO to alter the name to a more pragmatic one6. It is rare for the WHO to rename an old disease, although not uncommon. Although the WHO has named several ailments immediately after they appeared, like severe acute respiratory syndrome and coronavirus disease 2019, this seems to be a one-off occasion that it has renamed a disease years after it was initially documented. The WHO also acted judiciously in dropping the word Mongolism that designated Downs syndrome. It also omitted two Greek alphabets, Nu and Xi, while identifying coronavirus variants owing to a likely misunderstanding with the keyword 'new' linking with Chinese surnames. As a result, the name Omicron was coined. The WHO has already altered the names of two main MPX virus strains (clades), Congo Basin and West African clades, eliminating geographical links. The WHO revised those to Clade I and Clade II in August 2022. Clade II was further classified into IIa and IIb to group the prevalent variants in West Africa from others active in last year's worldwide epidemic7. The WHO encourages avoiding names, places, occupations and animals while naming to address stigmatisation8. Names of novel diseases should be assigned to minimise the unwarranted negative influence on trade and commerce, tourism and animal well-being, as well as avoid being felonious to a provincial, skilled or indigenous group. The WHO designates nonoffending names to new and prevailing illnesses through consultation with the WHO Member States. Out of the many ideas submitted, mpox and greypox (gpox) seemed more justified and self-explanatory. The mpox is an acronym for monkeypox, and the greypox (gpox) refers to the phenotypic mark (greyish blisters) of the disease9. These are benign terms as they are in no way associated with a location, ethnic group or animal. Thus, WHO suggests embracing 'mpox' as the novel name, and mpox shall replace monkeypox as the selected name following a year phase-out period. The justification, technical suitability, existing scope of use, pronounceability, useability across languages, absence of geographic or zoological hints and simplicity in reclaiming historical material were all factors considered for the suggestions. While the newly coined mpox shall be added to the ICD-10 (International Classification of Diseases-External 10th Revision) website in the meantime, the term 'monkeypox' shall continue to be a search phrase in ICD to reflect the historical data. Thus, the associated barrier to public health needs to be broken, as the humiliation associated with the name 'monkeypox' could possibly turn people away from testing and vaccinating. A benign term will now ease these individuals from receiving the treatment, funds and assistance they need for their own safeguard as also the public at large. Hence, considering the name of this decades-old disease as discriminatory, the WHO encourages accepting the new term (mpox) and will use it in its network. Additionally, the focus is needed for active and rapid acknowledgement and adoption of the use of 'Mpox' by the scientific journals and medical community, primarily physicians who do not work in the Infectious Disease departments. Ethical approval Not applicable. Sources of funding The authors declare that they have no financial conflict of interest with regard to the content of this report. Author contribution P.C.G. and P.S. developed the original draft; A.G., B.K.P. and R.S. reviewed and edited the manuscript. All authors read and approved the final manuscript Conflicts of interest disclosure There were no conflicts of interest. Research registration unique identifying number (UIN) None. Guarantor Ranjit Sah. Data availability All data are included in the manuscript.